View Research by Author - Jamie Rubenstein

Citation URL: http://www.urban.org/JamieRubenstein

This article examines experiences under Medicaid and the State Children's Health Insurance Program (SCHIP), drawing on surveys of over 3,000 enrollees in California and North Carolina in 2002. In both States, Medicaid enrollees were less likely than SCHIP enrollees to have parents who were covered by employer-sponsored insurance (ESI). With the exception of dental care and provider perceptions, access experiences were fairly comparable across the two programs, despite differences in the characteristics of the children served by the two programs. Relative to being uninsured, Medicaid enrollment was found to improve access to care along a number of different dimensions, controlling for other factors. Furthermore, this study emphasizes the need for continued evaluation of access to care for both programs.

Congress mandated in the Balanced Budget Refinement Act of 1999 (BBRA) that the Secretary of the U.S. Department of Health and Human Services conduct an independent comprehensive study of the State Children's Health Insurance Program (SCHIP). This report presents the findings from the mandated surveys of SCHIP enrollees and disenrollees in 10 states (conducted during 2002). SCHIP programs were found to provide health coverage to the population SCHIP was intended to serve, primarily children who would otherwise have been uninsured. The programs availed enrollees of needed primary and other health care services, and were found to have a positive impact on enrollees' access to health care services, leaving enrollees with fewer unmet needs than they would have had in the absence of SCHIP. Families were satisfied with the ease of enrolling children, many of whom remained enrolled for 12 months, depending on the state.

In early 2003 San Mateo County, California launched the Children's Health Initiative (CHI), a program to ensure that all children have access to comprehensive health insurance coverage. The report describes the governance structure for the CHI; its financing; enrollment growth (for all three public programs); access to services; use and cost of services for all three public programs; satisfaction on the part of both parents and providers; prior insurance and crowd-out; and the effect the initiative has had on hospital finances. Areas identified as needing attention include improving access to after-hours and dental care; increasing the use of preventive service; and developing new sources of financing for the CHI.

Return to list of authors